• Lead child protection roles not in place at numerous English trusts
  • Demand for paediatric specialists outstrips supply across the UK
  • Royal College warns of “concerning gap” in services for vulnerable children

“Widespread vacancies” and a lack of child protection roles in NHS organisations are putting vulnerable children at risk, a report has found.

The Royal College of Paediatrics and Child Health urged the government to make sure child protection roles exist without exception in the document published Monday.

The analysis of census data found almost half of English trusts (45.1 percent) do not employ or advertise for a named doctor for looked after children. The government expects all providers to appoint this statutory role, which promotes good practice in caring for children in care.

More than a third of trusts (36 per cent) do not have a designated medical officer for special educational needs and disability role, and almost a quarter (23 per cent) do not have a designated doctor for child deaths role.

Even when these roles are in place and filled, many staff are not given enough time to complete their duties, the analysis stated. In some cases, individuals have been given more than one of these roles in an effort to meet demand.

Although the college recommends how much time should be set aside for the roles, which varies from role to role, trusts are free to allocate time as they see fit. The positions do not come with extra pay.

The report argued a lack of lead child protection roles makes it more likely that clinicians will be asked to perform tasks they have not been trained for, placing “an already vulnerable group at greater risk”.

‘A concerning gap’

It added vacancies in paediatric care are making the situation worse, leaving a “concerning gap” in provision for vulnerable children and their families. The college estimates 850 more paediatric consultants are required to meet current demand in the UK. Although paediatric consultant numbers have risen across the UK in recent years, almost a quarter are working less than full time. The latest census in 2017 listed 4,306 paediatric consultants so the extra 850 would represent an increase of 21 per cent.

The percentage of filled trainee roles is also of concern, the report stated. Last year, only 87.5 per cent of ST1 paediatric roles were filled across the UK in 2018 — a fall of more than 2 percentage points from 89.6 per cent in 2017.

RCPCH officer for child protection Alison Steele said: “In many parts of the UK, vital child protection roles simply don’t exist. Even where they do, they are too often vacant or filled by clinicians who have neither the time nor the support to deliver the duties of the role.

“The reality is we don’t have enough suitably trained paediatricians to fill all the vulnerable children posts. We are storing up significant future problems with our failure to adequately resource the specialty.”

The college called on the government to review the need for additional roles, create guidance for each UK country and make sure each lead role holder is properly trained. It also said more paediatricians needed to be trained and recruited.

NHSE’s response

An NHS England spokesman did not dispute the college’s findings, but said all children in care had access to a named looked after children health professional, even if through another trust.

He said: “Every looked after child, wherever they are in the country, has access to a named paediatrician and all trusts have a named doctor or nurse.

“And as part of the NHS long-term plan all looked after and adopted children will have access to a key worker by 2023-24.”

Statutory guidance published in 2015 states all providers should have both a named doctor and nurse for looked after children.

Responding to NHSE’s comments, Dr Steele told HSJ access to general consultant paediatricians was not always enough for this group of vulnerable children.

She said: “[Child protection leads] are there because they have expertise in their particular area. They can advise on clinical cases, they can teach and they can supervise. That’s why the government deemed these roles necessary.

“It’s a great concern when those roles aren’t filled because you’ve lost your system’s clinical experts.”

The Department of Health and Social Care declined to comment.